Police Custody Healthcare for Nurses and Paramedics E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
An essential resource for nurses and paramedics navigating the intricate world of police custody, providing a solid guide for both the novices and the veterans in the field
Across the UK there are on average over 750,000 episodes of police detentions annually, the equivalent of over 2,000 a day. Each one is entitled to healthcare comparable to the wider community. It is estimated on average 54% of these detained individuals are referred to a healthcare professional because of a complex mix of physical health, mental health, medication, substance misuse or social issues. Healthcare professionals working in custody must navigate this complex mix while working within a short-term detention setting.
Police Custody Healthcare for Nurses and Paramedics offers a thorough, accessible introduction to this subject and its key aspects. Nurses and paramedics working in police custody healthcare settings will find a volume that addresses their specific needs, with guidelines for understanding initial patient contact, potential comorbidity, mental illness, forensic sampling, documenting injuries, writing statements, and much more. Aligned to the UK Association of Forensic Nurses and Paramedics’ Advanced Standards in Education and Training (ASET), this is a must-have resource for professionals in this growing area of practice.
Readers will also find:
- The first text written specifically for nurses and paramedics by nurses and paramedics with extensive experience in police custody
- Detailed discussion of topics including fitness assessment, medicines management, use of force restraints, and much more
- Pedagogical tools including self-assessment questions, case studies, and learning outcomes
Police Custody Healthcare for Nurses and Paramedics is ideal for trainee or registered nurses and paramedics working in police custody healthcare settings or other detention settings.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgements
About the Companion Website
CHAPTER 1: Introduction to Police Custody
Introduction
Consensus
Forensic Healthcare Practitioners
About Police Custody Healthcare
Detained Individuals
Conditions of Detention
Those Working in Custody
Legislation
Consent
Confidentiality and Information Sharing
Trauma‐Informed Care
Security
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 2: History of Forensic Science
Introduction
Early Evidence of Forensic Science
1700s – Advancements in Forensic Science
1813 – The Forensic Detection of Arsenic
1835 – The First Use of Bullet Comparison
1850s – The Use of Anthropometric Data
Dr Edmond Locard
1900 – Human Blood Groups Identified
1937 – The Discovery and Use of Luminol
Present Day Forensic Science
Conclusion
Resources
References
Further Reading
CHAPTER 3: Fitness Assessments
Introduction
Approach to Fitness Assessments
Fitness to Detain
Fitness to Interview
Fitness to Charge
Fitness to Release (Pre‐Release Risk Assessment)
Fitness to Travel
Fitness to Plead
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 4: Vulnerability and Appropriate Adults
Introduction
Appropriate Adults
The Role of an AA
Who Can Act as an AA
Children and Vulnerable People
Healthcare Responsibilities
Risks to Justice
Research Findings
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 5: Managing Long‐Term Conditions
Introduction
Cardiology and Vascular Disease
Respiratory Disease
Endocrine Disease
Gastrointestinal, Renal, Urology and Gynaecology Disease
Neurology
Musculo‐Skeletal Conditions
Infectious Diseases Including Sexual Health
Other Considerations
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 6: Mental Health
Introduction
Assessment
Care Planning and Pre‐Release Risk Assessment
Level of Observations
Our Approach
Children and Adolescents in Police Custody
Common Conditions Seen in Custody
Understanding Why People May Not Behave as Expected?
Common Treatments for Mental Health
Mental Health Legislation
Local Pathways for Mental Health
Additional Considerations
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 7: Medicine Management
Introduction
Medicines Legislation
How Patients Can Access Medicines
Holistic Assessment
How to Manage Patient's Own Medicines
PGD’s or Prescribing in Custody
Management of Controlled Drugs
Common Medications Given in Custody
Patient Safety
Continuity of Care Including Person Escort Record
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 8: Minor Illness
Introduction
Assessment
Headache
Toothache
Chest Pain
Abdominal Pain
Dizziness
Transient Loss of Consciousness (Collapse)
Cold and Flu‐Like Illnesses (Including Covid‐19)
Skin Infections
Chronic Leg Ulcers
Back Pain
Drug Reactions
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 9: Minor Injuries
Introduction
Assessment
Head Injury
Cervical Spine Injuries
Hand, Wrist and Finger Injuries
Joint Dislocations
Ankle Injuries
Tetanus
Bite Injuries
Wound Care
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 10 Substance Use and Misuse
Introduction
Definitions
Legislation
Drug Classification
Intoxication
Depressants
Opioids
Stimulants
Cannabinoids
Dissociatives
Conclusion
Learning Activities
Resources
References
CHAPTER 11: Use of Force
Introduction
Physical Restraint
Leg Restraints
Spit Hoods
Handcuffs
Batons
Irritant Sprays
Conducted Energy Device (Taser)
Dog Bites
Attenuating Energy Projectiles (Baton Rounds)
Restraint‐Related Deaths
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 12: Road Traffic Law and Procedures
Introduction
Road Traffic Legislation
Aviation, Train and Maritime Offences
The Healthcare Professional's Role
Road Traffic Procedures and Sampling
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 13: Evidence Collection (Documenting Injuries and Samples)
Introduction
Documenting Injuries
Forensic Samples
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 14 Safeguarding
Introduction
Safeguarding Children
Safeguarding Adults
Domestic Violence and Abuse
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 15: Writing Statements and Giving Evidence
Introduction
Overview of the Criminal Court Systems
Witnesses
Statements
Attending Court
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 16: Special Circumstances
Introduction
Terrorism Act 2000
Pregnancy
Children in Custody
Drug Concealment (Packer, Stuffer and Pusher)
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 17: Governance
Introduction
The Legislative Standards
Regulatory Environment
Healthcare Expectations in Police Custody
Quality and Safety for Healthcare in Police Custody
Introduction to Leadership
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 18: Professional Ethics
Introduction
Introduction to Ethics
Introduction to Law
Healthcare, Law and Ethics and Their Interface
Consent and the Mental Capacity Act
Confidentiality
Using a Decision‐Making Framework to Support Critical Thinking
Acting in an Objective and Impartial Manner
Conclusion
Learning Activities
Resources
References
Further Reading
CHAPTER 19: Emergencies
Introduction
Cardiac Arrest
A‐B‐C‐D‐E Approach
Acute Behavioural Disturbance
Alcoholic Ketoacidosis
Anaphylaxis
Asthma (Acute Exacerbation)
Cardiac Chest Pain
Delirium Tremens
Hypo/Hyperglycaemia
Overdose
Seizures
Sepsis
Wernicke's Encephalopathy
Deaths in Custody
Conclusion
Learning Activities
Resources
References
Further Reading
Index
End User License Agreement
List of Illustrations
Chapter 1
FIGURE 1.1 Novice to expert.
FIGURE 1.2 Police insignia. (a) Detention officer. (b) Constable. (c) Sergea...
Chapter 2
FIGURE 2.1 Anthropometric data sheet of Alphonse Bertillon.
FIGURE 2.2 Locard’s exchange principle.
Chapter 3
FIGURE 3.1 Custody record healthcare form.
Chapter 5
FIGURE 5.1 Types of insulin.
Chapter 8
FIGURE 8.1 Angina chest pain management.
Chapter 9
FIGURE 9.1 Range of motion. (a) Radial and ulnar deviation. (b) Wrist flexio...
FIGURE 9.2 Compartment syndrome of the hand.
FIGURE 9.3 Ottawa ankle rules. (a) Posterior edge or tip of the lateral mall...
Chapter 10
FIGURE 10.1 The Drugs Wheel.
FIGURE 10.2 Opioid use and substitution.
Chapter 11
FIGURE 11.1 Use of force options. (a) Handcuffs, (b) irritant sprays, (c) ba...
FIGURE 11.2 Nerve distribution (hand).
FIGURE 11.3 Taser devices.
FIGURE 11.4 Taser 7 probe removal.
Chapter 12
FIGURE 12.1 Blood procedure.
FIGURE 12.2 Labelled sample.
Chapter 13
FIGURE 13.1 The four‐way linkage theory.
FIGURE 13.2 Anatomical position and description.
FIGURE 13.3 Skin anatomy.
FIGURE 13.4 Category of injuries. (a) bruise, (b) abrasion, (c) laceration, ...
FIGURE 13.5 Examples of injuries (a–f).
FIGURE 13.6 Examples of injuries (g–l).
FIGURE 13.7 Barrier clothing.
FIGURE 13.8 Labelled evidence bag (may vary between force areas).
FIGURE 13.9 Example of labelled swab (varies between force areas).
FIGURE 13.10 Hand swabs.
FIGURE 13.11 Nail swabs.
FIGURE 13.12 Penile swabs – shaft and external foreskin (if present).
FIGURE 13.13 Penile swabs – Internal foreskin (if present), coronal sulcus a...
FIGURE 13.14 Nail clippings.
FIGURE 13.15 Pubic hair combing.
FIGURE 13.16 Pubic hair cutting.
Chapter 15
FIGURE 15.1 UK court system.
Chapter 17
FIGURE 17.1 A just culture guide.
Chapter 19
FIGURE 19.1 Adult life support algorithm.
FIGURE 19.2 Child cardiac arrest algorithm.
FIGURE 19.3 Resuscitation pit crew approach. 1 – HCP: The HCP bases themselv...
FIGURE 19.4 Airway management. (a) Head‐tilt‐chin‐lift, (b) jaw thrust, (c) ...
FIGURE 19.5 National early warning score 2.
FIGURE 19.6 Anaphylaxis management.
FIGURE 19.7 Asthma management (adult).
FIGURE 19.8 Asthma management (child).
FIGURE 19.9 ACS management.
FIGURE 19.10 Hypoglycaemia management.
FIGURE 19.11 An example of hyperglycaemia management.
FIGURE 19.12 Opioid overdose management.
FIGURE 19.13 Seizure management.
FIGURE 19.14 Sepsis screening tool community.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgements
About the Companion Website
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Police Custody Healthcare for Nurses and Paramedics
FIRST EDITION
Edited by
Matthew Peel
Leeds Community Healthcare NHS Trust, Leeds, UK & UK Association of Forensic Nurses and Paramedics
Jennie Smith
Mitie Care and Custody Health Ltd, London, UK & UK Association of Forensic Nurses and Paramedics
Vanessa Webb
Nurture Health and Care Ltd, Norwich, UK
Margaret Bannerman
Nurture Health and Care Ltd, Norwich, UK
This edition first published 2025© 2025 John Wiley & Sons Ltd
All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Matthew Peel, Jennie Smith, Vanessa Webb, and Margaret Bannerman to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, New Era House, 8 Oldlands Way, Bognor Regis, West Sussex, PO22 9NQ, UK
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Limit of Liability/Disclaimer of WarrantyWhile the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for:
Paperback ISBN: 9781394204892
Cover Design: WileyCover Images: © New Africa/Adobe Stock Photos, © Wasan/Adobe Stock Photos
List of Contributors
Margaret BannermanNurture Health and Care Ltd, Norwich, UK
Chris BathNational Appropriate Adult Network, Ashford, UK
Thomas BirdMitie Care and Custody Health Ltd, London, UK & UK Association of Forensic Nurses and Paramedics
Roxanna DehaghaniCardiff University, Cardiff, Wales
Alex GuymerMitie Care and Custody Health Ltd, London, UK
Nick HartLeeds Community Healthcare NHS Trust, Leeds, UK
Samantha HolmesLeeds Community Healthcare NHS Trust, Leeds, UK
Abdulla KraamNorth Lincolnshire CAMHS, Scunthorpe, UK
Amanda McDonoughMitie Care and Custody Health Ltd, London, UK
Esther McPhailMitie Care and Custody Health Ltd, London, UK
Dipti PatelMountain Healthcare Ltd, Stevenage, UK
Matthew PeelLeeds Community Healthcare NHS Trust, Leeds, UK & UK Association of Forensic Nurses and Paramedics
Nicola SheridanMitie Care and Custody Health Ltd, London, UK
Nick SkinnerLeeds Community Healthcare NHS Trust, Leeds, UK
Mandy SmailMitie Care and Custody Health Ltd, London, UK
Jennie SmithMitie Care and Custody Health Ltd, London, UK & UK Association of Forensic Nurses and Paramedics
Vanessa WebbNurture Health and Care Ltd, Norwich, UK
Preface
As a team of editors, each with a rich and diverse background in police custody healthcare and education, we are proud to present this comprehensive text, a culmination of our collective experiences and insights.
Our journey in this field has given us a profound understanding of the complexities and challenges inherent in police custody healthcare. Matthew brings over 12 years of experience in police custody. Jennie Smith, the President of the UK Association of Forensic Nurses and Paramedics, contributes with her 17 years of dedication to this field. Dr Vanessa Webb offers a unique dual perspective with her extensive experience as both a nurse and a doctor in police custody. Margaret, with her 20 years in higher education, has been pivotal in developing advanced standards in education and training for custody healthcare professionals, including the UK's first advanced master's programme in this specialty.
This text is born from our shared desire to create a resource that we wished we had at the outset of our careers. It is designed to guide those new to the setting and to enrich the practice of our seasoned colleagues. Our collective goal has been to create a book that not only educates but also resonates with the realities of working in such a dynamic and challenging environment.
We recognise that the practices in police custody vary greatly and can be inconsistent nationally. In this book, we have endeavoured to address these variations, aiming to bring clarity and a unified approach to the field. Our combined expertise and experiences have allowed us to cover a wide range of topics, offering practical advice, and in‐depth knowledge, all while highlighting the best practices and standards necessary for effective and compassionate care in custody.
We hope this book will serve as a resource for those navigating the intricate world of police custody, providing a solid foundation for both the novices and the veterans in the field. It is with great pride and anticipation that we share this work with you, our readers, as you embark on or continue your journey in this vital area of healthcare.
MATTHEW PEEL, JENNIE SMITH, VANESSA WEBB, AND MARGARET BANNERMAN
Acknowledgements
I extend my heartfelt thanks to those who have mentored and guided me throughout my career. Your mentorship and guidance have been invaluable in shaping my professional journey. Equally, I am grateful to the colleagues I have had the privilege to mentor. Your probing questions and eagerness to learn have in turn deepened my own understanding and perspectives.
I express my sincere appreciation to the editorial team – Jennie, Ness, and Marg. Your dedication, hard work and attention to detail have been pivotal in the creation of this text. A special note of thanks goes to all contributors who have enriched this book with their insights, whether through reviewing chapters, contributing texts, or sharing their expertise. Your collective contributions have been immeasurable.
I am grateful to Ian Peate for his support and advice during the initial stages of this project. His insights and encouragement were crucial in transforming the initial thoughts around this text into reality.
Lastly, but most importantly, I extend a massive thank you to my partner and family. Your unwavering support, understanding and love have been the bedrock upon which this endeavour was built. Without you, none of this would have been possible.
MATTHEW PEEL
When my best friend’s father mentioned that Merseyside Police were setting up a forensic nursing team and that I should apply for the manager role, little did I know the amazing journey he would set me upon.
I could not have imagined the all of the amazing, driven, passionate, funny and quirky people I would meet. Not only work colleagues, many of whom have become life‐long friends, but also the many hundreds of patients I have assessed that have all added to the rich tapestry my nursing career has been and continues to be. To every single one of those people, I am forever grateful and indebted. You have added the colour and texture to my working life, provided knowledge and experience from which I have been able to draw upon in this work.
I have special personal thanks to my colleagues, Esther, Mandy, Mandy, Nic and Alex who agreed without question to give their time and knowledge to bring this project to life, and to all of the contributors.
Matt, to me you are a visionary and an extraordinary talent, thank you for asking me to be part of this. For Marg and Ness for tolerating my slowness and procrastination, I am always thankful.
And finally, thanks to the person who allow me to be me, and do what makes me happy even if that is work. Who has never once complained about the hours spent at my laptop, taking from the time we could spend together. My John, I couldn’t do it without you.
JENNIE SMITH
As I reflect on my journey as an editor, my heart is filled with immense gratitude for the myriad of friends whose support has made it possible for the magic of unicorns, the sparkle of glitter and the promise of rainbows to align. At the heart of this remarkable adventure stands my family—Pete, Jack, Emma, Sam, Alice, Tommy and Arthur—whose unwavering faith in my endeavours lay the foundation of encouragement and love.
To Matt, Marg and Jennie—my esteemed editors— you have not only honed my thoughts with your profound wisdom but also enabled me to discover a harmony in our collective narrative.
There are a collection of others including Dipti that have been instrumental in weaving the fabric of this work. Thank you all for accompanying me on this journey. Your collective spirit and unwavering support have been the greatest gifts, reminding me that together, we are capable of creating something truly magical
VANNESSA WEBB
I thank my students over the years who have provided me with a wealth of knowledge and understanding of the challenges of working as a Forensic Healthcare practitioner within a Custody setting. You are all amazing individuals, working so hard to provide a quality service for your patients but so rarely appreciated.
However, my most sincere gratitude must go to my husband Neil, whose unwavering love and support mean the world to me. I also want to thank my family, especially my beautiful daughters; Katy and Sarah of whom I am so proud, as well as my parents, George and Betty, who shaped me into the person I am today. Thank you all for being there when I needed you.
MARGARET BANNERMAN
Reviewed from a Scotland and Northern Ireland perspective by:
Northern IrelandBarry NevinRN, BSc (Hons), NMP, DLMLead Nurse, Custody Healthcare, Belfast Health and Social Care Trust
ScotlandJessica Davidson MBERN, RNMH, QN, FRCNClinical Lead, South East Healthcare & Forensic Medical Services for People in Police Care, NHS LothianNurse Lead for SARCS NetworkProgramme Lead (Associate) – Advanced Forensic Nursing Practice, Queen Margaret University
About the Companion Website
This book is complemented by a companion website.
www.wiley.com/go/policecustodyhealthcare
The companion website provides colour images of all figures used in the book and 25 multiple‐choice questions for readers to test their knowledge and understanding regarding each chapter topic. Additionally, suggested responses to each scenario within the book are provided.
CHAPTER 1Introduction to Police Custody
Matthew Peel1, Jennie Smith2, Vanessa Webb3,, and Margaret Bannerman3
1 Leeds Community Healthcare NHS Trust, Leeds, UK & UK Association of Forensic Nurses and Paramedics
2 Mitie Care and Custody Health Ltd, London, UK & UK Association of Forensic Nurses and Paramedics
3 Nurture Health and Care Ltd, Norwich, UK
AIM
The aim of this introductory chapter is to provide a foundational understanding of the multifaceted realm of police custody healthcare in the United Kingdom. This will include the current state of forensic healthcare, the role of the healthcare professional, including training and induction. A broad overview of police custody, including the purpose, standards, individuals working in custody and the relevant legislations, will be provided.
LEARNING OUTCOMES
After reading this chapter, you will be able to:
Understand the current landscape and varying levels of consensus in forensic healthcare within the United Kingdom
Describe the structural and operational differences in police custody across the devolved nations
Identify the key demographics and vulnerabilities of individuals detained in police custody
SELF‐ASSESSMENT
What are the primary roles and responsibilities of HCPs in police custody?
Who are the typical detained individuals in police custody and what are their common demographics and vulnerabilities?
What standards of care and professional conduct are expected from HCPs working in police custody?
INTRODUCTION
Forensic science is guided by Locard's principle: ‘Every contact leaves a trace’ (Locard 1934). However, this ethos extends beyond physical evidence to the compassionate care that healthcare professionals (HCPs) provide to those detained, often in their most vulnerable moments. HCPs must strive to positively impact individuals through respect, dignity and hope. This approach blends assessment, examination and forensic strategy, along with advice, treatment, brief interventions and signposting, aiming to leave a beneficial impact on those they encounter.
This chapter delves into the unique challenges of police custody healthcare, where HCPs work with limited evidence‐based guidance to prioritise patient safety and well‐being. It addresses the diversity in practices, the absence of consensus in certain areas and the crucial role of risk assessment. It emphasises the need to balance healthcare needs and human rights with police procedures; this introduction sets the stage for exploring the dynamic and ethical landscape of police custody healthcare.
CONSENSUS
Within police custody, there is a scarcity of comprehensive, evidence‐based guidelines, providing a unique challenge for healthcare providers to navigate this uncertain terrain with the patient's safety and best interests, as their guiding principle. This has given rise to a spectrum of practices, each supported by its own evidence, albeit limited and characterised by distinct advantages and potential risks. The variety in clinical approaches reflects not a shortcoming but rather the complex nature of forensic healthcare, where clinical judgment intertwines intricately with the dynamic interface of police procedures and healthcare provisions. These practices are informed by a multifaceted interplay of factors. Recognising these variations, this text identifies areas where there is no consensus in practice, offering a comprehensive view of the diverse methodologies currently in use. For practitioners keen on delving deeper into the development of standardised practices and understanding how to bridge professional opinions, the National Institute of Clinical Excellence (NICE) provides invaluable resources, particularly its guidelines on managing differences in professional opinion.
FORENSIC HEALTHCARE PRACTITIONERS
Forensic healthcare practitioner (FHP) is the umbrella term for HCPs working in forensic healthcare settings (police custody and sexual assault referral centres), typically doctors, nurses, paramedics and midwives. They are distinct from those working in forensic mental health settings.1 Within this text, we will refer to FHPs as HCPs; however, both titles should be considered synonymous. In police custody, FHPs are more commonly referred to as:
Custody healthcare practitioner or professional
Custody nurse/paramedic
Custody nurse/paramedic practitioner
Forensic nurse/paramedic examiner
HCPs work at the front door of the criminal justice system, at an intersection between health, justice and forensics, with a dual patient and medico‐legal responsibility. For nurses and paramedics, this involves working at an advanced practice level with a high degree of autonomy and complex decision‐making (National Health Service 2017).
They have medico‐legal responsibilities, such as advising on fitness to interview. In addition, they are responsible for clinically examining and treating individuals presenting with undifferentiated and undiagnosed injuries or illnesses. They also undertake forensic examinations and sampling, providing written statements and oral testimony in court.
EDUCATION AND TRAINING
While HCPs bring with them several years of post‐registration clinical experience, knowledge and skills, they still require thorough induction, supervision and support. Figure 1.1 demonstrates a path from novice to expert2 (Benner 1984). As HCPs come from a wide range of clinical backgrounds and specialities, induction training programmes should be flexible to meet individual needs.
Induction
The UK Association of Forensic Nurse and Paramedics (UKAFNP) has developed standards for induction for healthcare providers to deliver locally, see Box 1.1.
Ongoing Training
Ongoing training and development are essential following induction across all healthcare settings and forensic healthcare is no different. Ongoing training should include both in‐house training and external training.
Post‐graduate Education (and Exams)
Several stand‐alone master’s level post‐graduate modules will be of interest to HCPs; these include:
Independent prescribing
Minor illness
Minor injuries
Mental health
Substance misuse
Human rights
Law
Alternatively, HCPs may undertake a master's level post‐graduate qualification.
Advanced forensic practice (PgCert, PgDip, MSc)
An advanced forensic practice programme,3 aligned to the UKAFNP ASET award (advanced standards in education and training), is available, including a taught and assessed clinical aspect evidenced by completing a competency document and taught and practical assessments of forensic science knowledge, practice and legal skills, including statement writing and providing oral evidence. These courses are a blend of forensics and advanced clinical practice. It is important to note that the requirements for ‘advanced practice’ differ across the different countries.
FIGURE 1.1 Novice to expert.
BOX 1.1 STANDARD FOR INDUCTION
Overview of organisation, including local mandatory and statutory training
Governance, patient safety, the duty of candour, reflection and equality, diversity and inclusion
Resuscitation
Medicines management, including patient group directions or non‐medical prescribing
Children's Act, Mental Capacity Act and consent
Mental Health Act, mental state examinations, including risk to self and others
Level 3 safeguarding children and adults; in addition to PREVENT and female genital mutilation
GDPR, confidentiality and records management
Forensic strategy, forensic sampling (including toxicology), chain of evidence
Ongoing continuity of care
Source: Adapted from UKAFNP (2023).
Advanced clinical practice (PgCert, PgDip, MSc)
Most universities offer advanced clinical practice programmes. Most programmes are generic, including a taught element and practical examination.
Licentiate of the Faculty of Forensic & Legal Medicine (FFLM)
The licentiate is an examination and competency assessment:
Part 1:
A three‐hour theoretical examination of medico‐legal and clinical practice, tested by a single best‐answer paper
Part 2
: Clinical competency assessment, tested by a 14‐station Objective Structured Clinical Examination (OSCE) and a short answer question paper
Completing all the elements may entitle the use of the post‐nominals LFFLM.4
Diploma of Legal Medicine
The Diploma of Legal Medicine (DLM) is a stand‐alone examination offered by the FFLM consisting of a three‐hour examination with 150 best‐of‐five multiple‐choice questions.
ABOUT POLICE CUSTODY HEALTHCARE
The healthcare provided in custody settings is a critical welfare component, ensuring individuals have timely access to physical and mental health assessments and treatments. This care must be patient‐centred, with HCPs advocating for individuals’ health needs, whilst remaining objective in the participation of the criminal justice system.
Substance misuse is a prevalent issue amongst the population. Providing appropriate services and managing medicines within custody suites is a complex task that requires specialised knowledge and skills. HCPs must be adept at handling these challenges, providing necessary interventions and referring to external services when appropriate.
The safeguarding of vulnerable individuals, including those with mental health issues or those who are intoxicated, is paramount. Police custody HCPs must work closely with custody officers to ensure individuals are monitored, ensuring signs of distress or deterioration are acted upon swiftly.
The responsibility also extends to the release process, where HCPs should ensure continuity of care and facilitate connections with community health services if necessary. This transition is a critical juncture where effective communication and planning can significantly impact the ongoing well‐being of the individual after release from custody.
In essence, the healthcare provision in police custody is not merely about treating illness or injury but is an integral part of the broader custodial care system. It requires a holistic approach, addressing physical, mental and social health determinants, contributing to the overall aim of the custodial system to ensure safety, security and preparation for release or transfer.
COMMISSIONING
The commissioning of police custody healthcare differs across the United Kingdom. In England and Wales, the commissioning of police custody healthcare rests with the local force and their Police and Crime Commissioner (or equivalent). However, they are supported by NHS England. Most forces outsource their healthcare to private healthcare organisations (most specialising in forensic healthcare) and some NHS Trusts. A very small number of forces deliver healthcare in‐house. In Scotland, commissioning sits with NHS Scotland and in Northern Ireland, the Police Service Northern Ireland works collaboratively with the Department of Health, the Public Health Agency and the Health and Social Care Trust.
DETAINED INDIVIDUALS
Individuals detained in police custody are often referred to as a ‘detained person’ or reduced to ‘DP’. The editors have purposefully chosen to avoid both ‘detained person’ and ‘DP’. Such language groups all those in custody as a single homogenous group, which fails to acknowledge or appreciate their individual histories, needs and vulnerabilities. Mostly, we refer to those in custody as ‘individuals’. However, other terms used are ‘suspect’ and ‘patient’, see Box 1.2.
CONDITIONS OF DETENTION
Individuals brought into police custody are forced into an environment where their freedoms are significantly restricted. Yet, it is a fundamental expectation their treatment is grounded in respect, dignity and upholding their human rights. This begins with the initial interaction and continues throughout the entire custody period. Police custody staff, including HCPs, play a pivotal role in this process.
Individuals are entitled to conditions respecting their dignity and basic human needs. Individuals should be housed alone in well‐ventilated, clean and properly heated cells, with access to bedding, toilet and washing facilities. Suitable clothing must be provided if necessary. Individuals are entitled to at least three meals daily with additional drinks, time outdoors for fresh air, and specific health, hygiene and welfare provisions, such as menstrual products. Faith‐related items should be made available as required. Additionally, they have the right to an uninterrupted rest period of 8 hours within a 24‐hour time frame.
Individuals’ diverse needs must be recognised and met. This involves a thorough risk assessment to manage any health, welfare or security concerns effectively. The assessment must be competent, and individuals must be informed of their rights and entitlements promptly and clearly (see Box 1.3). The custody environment itself must be safe and clean, and any use of force must be lawful, necessary and proportionate.
BOX 1.2 DESCRIPTIVE TERMS USED
Individual
For the most part, the text uses the term individual, recognising their own unique experiences, beliefs, vulnerabilities and needs.
Suspect
Used where a person is under investigation or arrest and, is going to be interviewed or have forensic samples taken (including road traffic procedures). Not all those detained in custody are suspects.
Patient
An individual who requires clinical attention or treatment.
BOX 1.3 SUMMARY OF RIGHTS AND ENTITLEMENTS
Right to free legal representation
Right to have someone informed of their arrest
Right to see a healthcare professional
Right to make a complaint
Right to communicate with their consulate (foreign nationals)
SCENARIO 1.1 Conditions of detention
A 45‐year‐old male with known arthritis was brought into custody on a wet, chilly winter night. In the morning, he complains of not feeling well and he is booked to see the HCP, where he states he is stressed from the arrest and feels increasingly uncomfortable as the cell temperature dropped during the night. He reports he was left in wet clothing in a cold cell without a blanket overnight. He appears distressed and upset, his heart rate and blood pressure are raised and his temperature is 35.2°C.
Outline your approach and clinical management of this individual
How do you respond to his complaints about detention?
What is the mechanism or structure for reporting concerns about an individual's conditions of detention?
The expectations and conditions outlined are comprehensive and demanding. Yet, they are crucial for safeguarding the health and well‐being of individuals, ensuring legal compliance, and fostering public trust in the police. HCPs working in this environment are not only caregivers but also custodians of human rights and their role is vital in upholding the standards in police custody.
THOSE WORKING IN CUSTODY
Various roles work in custody, including numerous police staff and outside agencies. Each has its own defined role and scope. There may be some regional differences.
POLICE STAFF
There are several ranks of police staff working in police custody, identifiable by the insignia on their epaulettes, see Figure 1.2.
Custody Officer (Custody Sergeant)
The Custody Officer is an officer at least a rank of Sergeant. Their role involves managing and leading the custody suite, including the care and welfare of detainees. The Custody Sergeant is responsible for authorising or refusing detention of persons presented to them and ensuring adherence to the Police and Criminal Evidence Act 1984 (PACE) Codes of Practice (or equivalent). They also direct resources to ensure safe detention and delegate tasks to assist them in the suite's safe and lawful operation. In England, Wales and Northern Ireland, a Custody Sergeant can authorise non‐intimate samples.
Detention Officer
A Detention Officer, sometimes called a Civilian Detention Officer, assists Custody Sergeants in processing individuals arrested and detained. This includes undertaking regular observations and providing food and drinks. They also assist by taking fingerprints, photographs and deoxyribonucleic acid (DNA) samples. If needed, they are involved in restraints. Detention Officers are civilian employees; Police Constable Gaolers are police constables who perform the same role in custody.
Inspector
In England, Wales and Northern Ireland, before charge, Inspectors review each detention six hours post‐detention and then every nine hours following to ensure detention remains necessary. Inspectors can authorise intimate samples. In England and Wales, individuals arrested and detained under Section 136 of The Mental Health Act 1983, an Inspector (or above) must authorise their detention in custody.
In Scotland, Inspectors must review the detention of any child likely to be detained over four hours. Inspectors review each detention following 6 hours of detention, then review at 12 hours and authorise (if necessary) a 12‐hour investigative extension, which is then reviewed after 6 hours (or 18 hours of detention). Inspectors can authorise non‐intimate samples only.
Superintendent
In PACE (and PACENI) a Superintendent has the authority to extend the maximum period a person may be detained without charge. After an initial detention period and the first review, if further detention is deemed necessary, a Superintendent can authorise an extension by up to 12 hours. The Superintendent's role is critical in ensuring the extension of detention is justified, documented and in accordance with the legal framework provided by PACE or PACENI.
APPROPRIATE ADULTS
Appropriate Adults (AA) help safeguard the rights and welfare of juveniles (under 18) and vulnerable adults detained or questioned by the police. Their duties include ensuring individuals understand their rights, their reason for detention and the police. Additionally, they can ensure legal rights are exercised, such as consulting with a solicitor. For further information, see Chapter 3 – Vulnerability and Appropriate Adults.
FIGURE 1.2 Police insignia. (a) Detention officer. (b) Constable. (c) Sergeant. (d) Inspector. (e) Chief inspector. (f) Superintendent. (g) Chief superintendent. (h) Assistant chief constable. (i) Deputy chief constable. (j) Chief constable (regional variations exist).
LIAISON AND DIVERSION PRACTITIONERS
Liaison and Diversion (L&D) services differ across the United Kingdom. In Wales, it is known as the Criminal Justice Liaison Service and Northern Ireland currently has no such service. NHS Scotland has most recently introduced L&D practitioners in response to Scotland's Mental Health Strategy (2017–2027). L&D practitioners serve as a bridge between the criminal justice and mental health services. They screen for vulnerabilities, such as mental health issues, learning disabilities and substance misuse. Their role includes early intervention, diverting people to appropriate health, social care or other supportive services, reducing the likelihood of reoffending. L&D is commissioned by the NHS. L&D practitioners include registered professionals (i.e. nurses and social workers) and may include unregistered mental health professionals. It is important to be familiar with your local service and the referral mechanisms.
SOLICITOR AND LEGAL REPRESENTATIVES
A solicitor or legal representative plays a crucial role in the criminal justice process in police custody. They provide legal advice, guiding their clients and advocating for their interests. This involves explaining legal rights, the implications of different choices, such as whether to provide responses during a police interview and potential legal strategies. Across the United Kingdom, individuals detained in police custody are entitled to free, independent, legal advice at any time. This can include a named solicitor (or firm) or can be provided through the duty scheme. The scheme provides legal representation to individuals in police custody and is available 24 hours a day, 365 days a year.
DRUG INTERVENTION PROGRAMME WORKERS
Drug intervention programme (DIP) workers are a critical part of the UK's strategy to address drug abuse, particularly within the criminal justice system. The program aims to engage drug‐misusing offenders by involving them in formal addiction treatment and support, thereby aiming to reduce drug‐related harm and criminal behaviour. Individuals are typically identified through the criminal justice system at key points, such as after a positive drug test in police custody, and are then directed towards treatment and comprehensive support.
LEGISLATION
HCPs working within police custody must navigate a complex interplay of healthcare ethics, patient care and legal mandates. A deep understanding of relevant legislation such as PACE, PACENI and the Criminal Justice Act (Scotland) 2016 is vital for ensuring legal compliance in their professional activities. This knowledge base assists HCPs in upholding the rights of individuals, guaranteeing those in custody receive their entitled medical care and legal representation.
Furthermore, a firm grasp of these laws underpins the ethical practice of healthcare within the custodial setting. It allows HCPs to advocate effectively for the health needs of individuals, particularly those who are most vulnerable, such as those experiencing mental health crises or substance misuse issues. By understanding the legal framework, HCPs are better equipped to manage the risks associated with custodial care, ensuring the welfare of individuals and mitigating potential harm.
Effective communication between HCPs and police is critical, and being knowledgeable with custody‐related legislation facilitates clearer dialogue and understanding. For HCPs involved in forensic evidence collection, legal literacy is essential to ensure evidence is managed in a manner that maintains its integrity for potential court proceedings.
Additionally, the professional accountability of HCPs extends beyond immediate patient care. They may be called upon to provide testimony or input during legal proceedings or inquiries. In such scenarios, their insight into the legislative context is indispensable for contributing objective, accurate and authoritative information.
Lastly, HCPs with a sound understanding of the legalities surrounding police custody are well‐positioned to influence policy development. They can offer informed opinions on the creation and refinement of protocols and guidelines that directly impact the health and well‐being of individuals. Through this, HCPs not only fulfil their role as caregivers but also as crucial advocates for health in the justice system.
POLICE AND CRIMINAL EVIDENCE ACT 1984
The Police and Criminal Evidence Act 1984 (PACE) is a significant piece of legislation in England and Wales that sets out the powers and responsibilities of the police concerning the prevention and investigation of crimes. PACE and its accompanying Codes of Practice aim to balance the needs of the police to gather evidence with the rights and freedoms of the public. See Box 1.4 for an overview of the main provisions.
BOX 1.4 OVERVIEW OF PACE
Police powers
PACE defines the powers of the police to stop and search individuals, enter and search premises, seizing property found during searches. It also outlines the conditions under which the police can arrest and detain individuals.
Detention and treatment
PACE stipulates how long a person can be held in police custody before they are charged or released, and it sets standards for the treatment and welfare of detainees to ensure their rights are protected while in custody.
Evidence
PACE provides a framework for the gathering, handling, and admissibility of evidence. This includes rules on the conduct of searches, the seizure of items, and the handling of confessions and statements.
Codes of practice
The Act is accompanied by Codes of Practice (Codes A to H) that provide detailed guidance on various aspects of police procedures:
Code A
: Governs the practice of stop and search
Code B
: Deals with searching of premises and seizure of property
Code C
: Concerns the detention, treatment, and questioning of persons by police officers
Code D
: Relates to the identification of persons by police officers
Code E
: Cover the audio recording of interviews with suspects
Code F
: Cover the visual recording of interviews with suspects
Code G
: Relates to the powers of arrest
Code H
: Involves the detention, treatment and questioning of terrorism suspects
Code I:
Involves the detention, treatment and questioning of persons in relation to the National Security Act 2023
Safeguards
PACE introduced several safeguards to prevent the misuse of these powers, including the requirement for the police to maintain detailed records of searches, arrests, and detentions, and the provision of legal advice and appropriate adults.
Independent oversight
The Act also established the Police Complaints Authority (which has since been replaced by the Independent Police Complaints Commission and then the Independent Office for Police Conduct) to provide independent oversight of complaints against the police.
PACE was designed to standardise police practices across England and Wales to ensure fair treatment for individuals who encounter the police. It is often updated and amended to adapt to new legal decisions and changes in society, so it is crucial for HCPs to stay current with these updates. For HCPs working in police custody, understanding PACE, in particular Code C, is essential to ensure the rights and well‐being of individuals are upheld.
POLICE AND CRIMINAL EVIDENCE (NORTHERN IRELAND) ORDER 1989
The Police and Criminal Evidence (Northern Ireland) Order 1989 (PACENI) is the PACE equivalent legislation for Northern Ireland. While it is broadly similar to PACE and was based on the same principles, it has been tailored to fit the specific legal and policing context of Northern Ireland. PACENI also has its own set of Codes of Practice, which broadly mirror those in PACE, addressing similar areas such as stop and search, arrest, detention and the treatment of detainees, but with adjustments for local requirements.
CRIMINAL JUSTICE ACT (SCOTLAND) 2016
The Criminal Justice Act (Scotland) 2016 is a legislative measure enacted by the Scottish Parliament that brought about key changes to criminal practices and procedures within Scotland. Aimed at modernising and streamlining the Scottish criminal justice system, the Act sought to improve its overall efficiency.
The legislation was approved by the Scottish Parliament on 8 December 2015 and granted royal assent on 6 April 2016. The provisions of the Act were implemented in stages from 2016 to 2019 and have been subject to further modifications since then. Unlike PACE and PACENI, there are no Codes of Practice. Rather, Police Scotland has developed several standard operating procedures.
The initial part of the Act overhauled the police's authority concerning the arrest and holding of individuals. It replaced the pre‐existing common law powers and various statutory detention powers with a unified statutory power of arrest, akin to the one outlined in section 24 of PACE applicable in England and Wales. According to section 3 of the Act, individuals arrested under this new power must be cautioned and informed about the grounds for their arrest. Additionally, the Act enshrines the right of those in police custody to legal counsel, a move influenced by the Cadder v HM Advocate case and the subsequent Carloway Review. Section 50 obligates the police to avoid holding individuals in custody without reasonable or necessary cause.
CONSENT
Consent is a fundamental principle that guides the ethical and legal practice of HCPs. Consent may be complicated in custody; individuals may be under significant stress or influenced by substances, mental health issues, or the intimidating environment of custody. Consent, at its core, is the voluntary agreement to an intervention by a competent and informed individual. It must be given freely, without coercion and with an adequate understanding of the nature and consequences of the procedure or treatment.
Consent may be implied and explicit. Implied consent occurs when an individual's actions indicate consent, such as presenting an arm for a blood pressure check. Alternatively, express consent is given either verbally or in writing and is necessary for more significant interventions. While practice varies, there is often a preference for written consent before undertaking forensic examinations.
CONFIDENTIALITY AND INFORMATION SHARING
In police custody healthcare, maintaining confidentiality while effectively sharing information with the police is a delicate balance. This is discussed further in Chapter 18 – Professional ethic; however key principles are identified as follows.
CONFIDENTIALITY AND LEGAL OBLIGATIONS
Confidentiality is a cornerstone of healthcare, embedded deeply in the individual codes of practice for nurses and paramedics. In the United Kingdom, this is further reinforced by legislation such as the Data Protection Act and the Human Rights Act.5 These laws provide a legal framework that protects personal information, requiring HCPs to handle it with the utmost care and discretion.
BALANCING CONFIDENTIALITY WITH INFORMATION SHARING
In police custody, HCPs often find themselves in situations where they need to share information with the police. This is crucial for ensuring proper care and preventing harm. However, this need must be balanced against the individual's right to confidentiality. The decision to share information should be guided by professional judgment, considering the potential benefits and risks. Information should only be shared if doing so reduces the risk of harm to the individual. Police asking for speculative searches of an individuals' health or medication records should be refused.
LIMITS OF CONFIDENTIALITY
When interacting with individuals in custody, it is important to inform them about the limits of confidentiality. Such disclosure would typically be in situations where there is a significant risk of harm to the individual or others, including self‐harm or safeguarding concerns. Individuals should understand that conversations with HCPs are not subject to legal privilege and in certain circumstances, a court may require HCPs to disclose confidential information. Therefore, they should avoid discussing the allegation against them.
COMPLEX SITUATIONS
There are instances where an individual might expressly forbid the sharing of certain information with the police. In such cases, HCPs should consult their colleagues or superiors to weigh the ethical implications and legal requirements. This consultation process is essential for making informed decisions about whether to breach confidentiality, especially when the individual's or public's safety is at stake. HCPs may wish to seek advice from their Caldicott Guardian, who are experts in confidentiality and information‐sharing issues within healthcare settings. They can provide guidance on the legal and ethical implications of sharing patient information, helping HCPs navigate the complexities of such situations.
TRAUMA‐INFORMED CARE
Trauma‐informed care is an approach in healthcare that assumes an understanding of the prevalence of trauma and recognises the widespread impact of trauma on individuals, including patients, staff and others involved in the healthcare system. It is an approach particularly relevant in settings such as police custody healthcare, where individuals may have experienced various forms of trauma. There are six key principles of trauma‐informed care, see Box 1.5.
For HCPs working in police custody, these principles should be integrated into all levels of organisational operation, influencing policy, physical space design, staff training and treatment to ensure services are delivered in a way that is respectful and appropriate for individuals who have experienced trauma.
Implementing trauma‐informed care can also involve specific strategies, such as training staff on recognising the signs of trauma, creating environments that avoid re‐traumatisation and developing policies that support recovery from trauma. This approach can be particularly critical when dealing with distressed individuals, mental health crises, substance misuse and the vulnerable.
Incorporating trauma‐informed principles could be beneficial, not only for the patients but also for the practitioners, as it can help in managing their own stress and preventing burnout.
SECURITY
HCPs working in custody must have an awareness of security measures to adhere to.
BOX 1.5 PRINCIPLES OF TRAUMA‐INFORMED CARE
Safety
Ensuring physical and emotional safety for patients and staff.
Trustworthiness and transparency
Assessments and decisions are conducted with transparency with the goal of building and maintaining trust among HCPs and patients.
Peer support
Peer support and mutual self‐help are key vehicles for establishing safety and hope, building trust and enhancing collaboration.
Collaboration and mutuality
There is recognition that healing happens in the meaningful sharing of power and decision‐making. The organisation recognises everyone has a role to play in a trauma‐informed approach.
Empowerment, voice and choice
Individuals' strengths are recognised, built on, and validated and new skills are developed as necessary. HCPs are facilitated to work collaboratively with patients in a way that is empowering and supportive.
Cultural, historical and gender issues
The organisation actively moves past cultural stereotypes and biases, offers gender‐responsive services, leverages the healing value of traditional cultural connections, and recognises and addresses historical trauma.
AWARENESS OF THE NATIONAL THREAT LEVEL
Awareness of the national threat level is paramount for HCPs working in police custody. This awareness becomes even more crucial in Northern Ireland, considering its unique history. HCPs must remain vigilant, especially in areas such as secure police car parks or secure entrances. The use of police ID for accessing restricted areas is a key protocol in ensuring only authorised personnel gain entry, thereby maintaining a secure environment. Therefore, HCPs should ask for the ID of anyone tailgating them entering (or leaving).
ESCORTING INDIVIDUALS
When escorting detained individuals, it is advised they walk a step or two ahead of the HCP. This practice allows the HCP to always keep the individual within sight, mitigating the risk of an attack from behind. This simple yet effective measure is vital for the safety of the HCP. Additionally, HCPs should be familiar with the panic alarms available on their route between the medical room and the custody desk.
MEDICAL ROOM SECURITY
Ideally, individuals will be seen in the medical room privately.6 However, in practice, there is no consensus and will vary between local services, practices and risk assessments. Custody is a relatively controlled environment with individuals searched and risk assessed. However, some may have a propensity for violence or aggression. Therefore, HCPs should take reasonable steps to protect themselves.
Sharp Objects
Sharp objects, such as scissors and sharps bins, must be kept securely and out of reach. Storing these items in cupboards or drawers reduces the risk of them being used inappropriately by individuals in custody.
Tidy Desk Policy
A tidy desk policy in medical rooms is essential. This involves ensuring only necessary items are on the desk, out of reach, reducing the risk of objects being taken into cells and used as weapons or for self‐harm. Desks should be checked after each assessment to ensure nothing is missing.
Data Security
Data security is a critical component of maintaining confidentiality and trust in the healthcare environment, especially in the sensitive setting of police custody. All HCPs must protect their passwords. Lock computers when not in use to prevent unauthorised access to sensitive information. This simple action can significantly reduce the risk of data breaches. Although much of today's documentation is digital, paper records must be stored securely. This involves locking file cabinets and ensuring that sensitive information is not left unattended. In addition to these measures, HCPs must also be cognisant of the General Data Protection Regulation (GDPR). GDPR requires the safeguarding of personal data and privacy for individuals within the European Union and the United Kingdom
Medication Security
The security of medication is of utmost importance. Medication cupboards should always be locked, and keys should be kept secure. Opening medication cupboards in the presence of detained individuals should be avoided to reduce risks.
SCENARIO 1.2 Security
You are asked to see a very angry male who has recently just come into custody. The custody risk assessment was not completed because of his level of aggression. He has requested to speak to the HCP because of his mental health.
Outline the risks associated with seeing this man in the medical room
What (if anything) can be done to mitigate the risks
Outline the risks associated with seeing this man at the cell
What (if anything) can be done to mitigate the risks
How would you respond to this request?
RISK ASSESSMENT AND COMMUNICATION
If possible, before any interaction with the individual, review the police risk assessment. This review, coupled with discussions with police and an examination of recent detention logs, helps HCPs understand their behaviour and potential risks.
CONCLUSION
This chapter has introduced the intricate landscape of police custody healthcare, a field where evidence is scarce and practices vary. In this complex environment, HCPs face the challenge of making decisions that prioritise the safety and well‐being of individuals, often in the absence of clear, evidence‐based guidelines. The diversity in approaches, as we have seen, is not a shortfall but a reflection of the multifaceted nature of forensic healthcare. It is a domain where clinical judgement must balance the scales between police procedures, healthcare needs, risk mitigation and human rights considerations.
As practitioners in this field, it is imperative to stay informed and adaptable, recognising the landscape of police custody healthcare is continuously evolving. Ultimately, the commitment to the welfare of those in custody remains the cornerstone of our practice, guiding us through the challenges and informing our decisions, ensuring every contact leaves a positive, lasting trace.
Throughout this text, readers will find various scenarios with probing questions. These are designed to expand the reader’s understanding of specific topics or subject areas. Readers are encouraged to work through and explore these scenarios alone or with their colleagues and peers, using them to generate discussions and appropriate approaches or responses. Example responses to each scenario can be found on the accompanying website.
LEARNING ACTIVITIES
Write a reflection relating to a confidentiality dilemma. Consider your attitude, values and beliefs along with the impact of any external pressure or influence from the police or detained individual. What were the tensions with your professional code of practice, if any?
Engage in role‐playing exercises to simulate interactions between HCPs, detained individuals and police staff, focusing on communication skills, confidentiality and handling complex scenarios.
Review and critique your current policies, consider the language used and if there is evidence, they are trauma‐informed. Identify areas for improvement or further research.
RESOURCES
Online
NHS England | About liaison and diversion |
https://www.england.nhs.uk/commissioning/health‐just/liaison‐and‐diversion/about/
Home Office & National Appropriate Adult Network | Guide for appropriate adults
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/117682/appropriate‐adults‐guide.pdf
Police Scotland | Standard operating procedures |
https://www.scotland.police.uk/access‐to‐information/policies‐and‐procedures/standard‐operating‐procedures/standard‐operating‐procedures‐a‐b/
Organisations
Faculty of Forensic & Legal Medicine |
https://fflm.ac.uk/
National Police Chief's Council |
https://www.npcc.police.uk/
Police Scotland |
https://www.scotland.police.uk/
Police Service Northern Ireland |
https://www.psni.police.uk/
UK Association of Forensic Nurses and Paramedics |
https://ukafnp.org/
REFERENCES
Benner, P. (1984).
From Novice to Expert: Excellence and Power in Clinical Nursing Practice
. Menlo Park, CA: Addison‐Wesley Publishing Company.
Locard, E. (1934).
La police et les méthodes scientifiques
. Paris: Editions Rieder.
National Health Service (2017). Multi‐professional framework for advanced clinical practice in England.
https://www.hee.nhs.uk/sites/default/files/documents/multi‐professionalframeworkforadvancedclinicalpracticeinengland.pdf
(accessed 4 November 2022).
UK Association of Forensic Nurses and Paramedics (2023). Standards for induction. LINK:
https://irp.cdn‐website.com/552775eb/files/uploaded/Standards_for_Induction_Final.xlsx
FURTHER READING
National Institute for Health and Care Excellence | Developing NICE guidelines: the manual | https://www.nice.org.uk/process/pmg20/resources/developing‐nice‐guidelines‐the‐manual‐pdf‐72286708700869
Notes
1
Forensic mental health service provides long‐term treatment, rehabilitation and aftercare for people who are mentally unwell or learning disabled and who are in the criminal justice system (courts or prisons).
2
Expert in the sense of Benner’s clinical expertise, this does not automatically confer expert witness status.
3
Programme titles may differ.
4
Requires annual membership to use postnominals.
5
Article 8 – Right to privacy.
6
HCPs should consider the need for a chaperone, not just for security reasons. Male HCPs should consider a female chaperone when seeing females.
